title: Coronary revascularization in patients with liver cirrhosis.
abstract: BACKGROUND
  Liver cirrhosis is a major risk factor for cardiac surgery using cardiopulmonary bypass. However, percutaneous coronary intervention (PCI) or off-pump coronary artery bypass graft surgery (OPCABG) may be a less invasive alternative strategy.
  
  
  METHODS
  Among the 9,877 patients undergoing first PCI or CABG enrolled in the CREDO-Kyoto Registry (a registry of first-time PCI and CABG patients in Japan), 332 patients diagnosed with liver cirrhosis were entered into the study (age 67.1±9.4 years; 246 male). Liver cirrhosis was diagnosed by liver biopsy or signs of portal hypertension with characteristic morphologic liver and spleen changes.
  
  
  RESULTS
  A total of 233 patients received PCI, 58 conventional on-pump CABG (CCABG), and 41 OPCABG. Median follow-up was 3.3 years. The PCI group included less complex coronary lesions such as triple vessel and left main disease (p<0.01 each). Propensity score adjusted in-hospital mortality after CCABG or OPCABG was higher than that after PCI; however, the differences were not significant (odds ratio [95% confidence interval]: 6.84 [0.52 to 90.8], p=0.14 for CCABG versus PCI; and 1.86 [0.08 to 45.8], p=0.71 for OPCABG versus PCI). Adjusted overall mortality after CCABG or CABG was lower than that after PCI, but the differences were not significant (0.66 [0.31 to 1.40], p=0.28; and 0.64 [0.28 to 1.49], p=0.31, respectively). Approximately two thirds of patients died of noncardiovascular morbidities (malignancies, including hepatocarcinoma, or hepatic decompression).
  
  
  CONCLUSIONS
  Because overall noncardiovascular mortality is high among patients with liver cirrhosis, complete revascularization may not be associated with better survival outcomes. Further study is warranted to determine the impact of a coronary revascularization strategy for liver cirrhosis patients.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, and Translational Research Center, Kyoto University Hospital, Kyoto, Japan. marui@kuhp.kyoto-u.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Marui
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Senri
authors.initials: S
authors.lastname: Miwa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Minakata
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nakata
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ikeda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D001707:Biopsy, Needle; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome